Pruritus: a new look at an old problem

Pruritus, a frequent complaint heard by family physicians, is a complex physiological phenomenon mediated by histamine and other peptides. It is associated with a number of common dermatologic diseases but has significant psychological factors as well. In some patients pruritus may be an important marker of systemic disease. Diagnostic approach includes a careful physical examination of primary skin lesions and goal-directed laboratory tests. Careful skin care and oral antihistamines are basic measures to alleviate pruritus.     

Ethics and Medicaid: a new look at an old problem.

Recent proposals to reform Medicaid, driven primarily by the need for cost containment, rarely pay explicit attention to values. This paper presents the Medicaid Values Framework, the authors' interpretation of a set of societal ideals embodied in Title XIX of the Social Security Amendments of 1965. The Framework comprises seven interlocking values that are stratified into three interdependent tiers--access, quality, and equity. We use the access and equity tiers to analyze treatment of Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) recipients under Medicaid. We document striking inequities in eligibility standards and in funding for the two groups--inequities that unexpectedly fail to translate into marked disparities in access to Medicaid. In conclusion, we comment on why the present inequities exist and why they are ethically unacceptable.     

Goodman and Kruskal's lambda: a new look at an old measure of association

We examine Goodman and Kruskal's lambda using Efron's approach to regression and analysis of variance (ANOVA) for zero-one outcome data. For a binary response cross-classified by a single nominal predictor, we present a computationally simple ANOVA table in which lambda is analogous to Pearson's R-square. We characterize the relationship between lambda and the commonly used apparent error rate in logistic regression, and show that lambda is based implicitly on a prediction rule for a saturated model with classification level 0.5. This relationship suggests that we can correct the apparent error rate for chance by defining a natural generalization of lambda that we call PRE, the proportional reduction in error. We illustrate the use of lambda and PRE in an analysis of prognostic factors for one-year survival in children with the acquired immunodeficiency syndrome (AIDS).     

Using blocks to build art concepts: A new look at an old friend

Blocks are common materials, used by young children. Educational texts have categorized block building as an art activity, yet few if any, art concepts that can enhance aesthetic knowledge have been noted. Art concepts that can be developed, how block building can be facilitated and how blocks represent the young child's art world will be discussed in this article. The examination of the process and product of block building can assist the child in using this familiar medium in a new way.